Helping when patients can’t afford their medication
Key Takeaways
In 2020, the cost increases for one-third of drugs covered by Medicare outpaced the current rate of inflation.
When approaching a patient about financial assistance for prescription medications, keep the three Ps in mind: polite, private, and persistent.
There are various prescription assistance programs available for patients.
When you prescribe a drug to a patient, you hope they’ll take it. The reality, however, is that many patients struggle financially.
They are encumbered by so many other basic costs of living that paying for expensive prescription drugs or their high copays can seem a lower priority. You and they both know, though, that these medications are necessary for good health.
Fortunately, there are resources you can direct your patients to that can help them with high medication costs.
Scope of the problem
The Kaiser Family Foundation (KFF) has been keeping close tabs on rising drug prices—especially in light of inflation. It found that 50% of all drugs covered by Part D of Medicare, and 48% of all drugs covered by Part B, experienced price increases greater than the rate of inflation (ie, 1%) between July 2019 and July 2020.
Inflation rates have ballooned recently.
At the time of the KFF analysis in February 2022, the inflation rate was 7.5%; in 2020, one-third of Medicare-covered drugs experienced price increases of 7.5% or more.[]
Rising drug prices are a global problem that requires legislative attention. Consequently, the Build Back Better Act would permit the federal government to negotiate drug prices in Medicare, cap out-of-pocket drug spending under Part D, and more. This legislation, however, has stalled in Congress.
Approaching the patient
Before offering specifics to your patients on how to deal with drug costs, it’s important to broach the subject in a considerate manner. Nobody likes to discuss financial hardship, as the topic may be sensitive and embarrassing to them.
An article from FPM offers advice on bridging the issue of drug costs with patients based around the three Ps—polite, private, and persistent.[]
Polite. Be sensitive to patients’ feelings about disclosing financial status. For instance, instead of asking “Are you able to afford this medication?” say “Are you going to have difficulty filling this prescription today?” In addition to covering the patient’s financial ability to pay for the medication, this alternative question can open up a discussion about other issues the patient has with drug adherence.
Private. Assure the patient that all financial disclosures will be kept confidential.
Persistent. When a patient says they have trouble paying for a drug, be persistent. Ask detailed questions as to why the patient has trouble. This will better help you direct them to the appropriate resources.
Help is available
There are various prescription-assistance programs (PAPs), including those sponsored by pharmaceutical companies, state programs, and nonprofits. They offer free or low-cost medicines for the uninsured, underinsured, and those who have trouble with high copays.
The benefits of such programs depend on numerous factors. Some patients may qualify for free medicines, while other programs may help reduce copays.[]
Keep in mind that each PAP has its own rules, and all have income guidelines that can vary. Each pharmaceutical company selects the drugs that are in its program and specifies how long the patient can receive assistance.
While some programs simply require a signed prescription, applications can be involved and require detailed medical and financial information. The physician may need to fill out a portion of the form. Some programs send the prescription to the patient’s home, while others send it to the doctor’s office, and even fewer to the pharmacy.
Most PAPs will cover refills needed for chronic disease. Some programs offer generic medications at fixed prices. Sometimes one dose of a medication is covered, while another isn’t.
Various organizations and medical societies offer a list of comprehensive PAPs, including:
Another option to decrease medication prices is manufacturer copay cards, which help with out-of-pocket prices.
These cards usually cover the cost of drugs that lack a generic version. There are requirements on who can receive them, and there can also be limits on how much is saved per month or year.[]
Sometimes, Medicare patients max out their yearly coverage of medications and enter the “coverage gap.” By choosing a different plan at a higher premium, this gap can be covered.[]
On a related note, Medicare and Social Security offer a plan called Extra Help, which offers discounted prices on certain generic drugs (ie, $3.95) and brand-name drugs (ie, $9.85) for those who qualify.
What this means for you
Inflation rates are unhinged, and in a post-pandemic financial reality, your patients may be feeling the pinch. Paying for the prohibitive costs of prescription drugs may be a lower priority to them, but they need them. Fortunately, there are various programs that can help. Share information about these with your patients. Be polite, private, and persistent when asking them about their ability to pay for medications.